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Vol. 159. Issue 8.
Pages 388-395 (October 2022)
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Vol. 159. Issue 8.
Pages 388-395 (October 2022)
Revisión
Esteatohepatitis no alcohólica
Non-alcoholic steatohepatitis
Visits
59
Manuel Romero-Gómez
Servicio de Aparato Digestivo, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERHD), Departamento de Medicina, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (HUVR/CSIC/US), Universidad de Sevilla, Sevilla, España
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Resumen

La esteatohepatitis no alcohólica forma parte del espectro de la esteatosis hepática metabólica (EHmet), que se caracteriza por la presencia de esteatosis hepática en pacientes con disfunción metabólica o inmunomediada asociada a obesidad, diabetes, síndrome metabólico, dislipidemia y enfermedades inmunomediadas. La EHmet es una enfermedad prevalente, heterogénea, compleja y dinámica. Es paucisintomática, manifestada por astenia y prurito que afecta la calidad de vida relacionada con la salud. El diagnóstico se realiza por métodos no invasivos bioquímicos o de imagen (ecografía y resonancia magnética) y biopsia hepática. Su tratamiento se basa en intervención en estilo de vida promoviendo dieta mediterránea hipocalórica con el objetivo de perder peso, ejercicio físico para combatir la sarcopenia, así como abstinencia completa de consumir alcohol; en caso de no respuesta se utilizarán fármacos para promover la regresión de la esteatosis, la inflamación y la fibrosis.

Palabras clave:
Esteatosis
Esteatohepatitis
Fibrosis hepática
Cirrosis hepática
Neoplasias extrahepáticas
Enfermedad cardio-vascular
Abstract

Non-alcoholic steatohepatitis belongs to the spectrum of metabolic-associated fatty liver diseases characterized by steatosis linked to obesity, diabetes, metabolic syndrome, dyslipidemia and immune-mediated disorders. The main features of MAFLD include high prevalence, heterogeneity, complexity and dynamic disease. Pruritus and asthenia are the main clinical manifestation that impact on quality of life and patient-reported outcomes. Biochemical or imagen-based non-invasive test have been implemented in the diagnostic process. Liver biopsy remains as the gold standard. Therapeutic options included life-style intervention. Mediterranean hypocaloric Diet to lose weight, exercise to fight sarcopenia and alcohol abstinence. In non-responders, drug-therapy focusing on obesity, diabetes and fibrosis using sequentially or combined to promote steatosis, inflammation and fibrosis regression.

Keywords:
Steatosis
Steatohepatitis
Fibrosis
Cirrhosis
Extrahepatic neoplasms
Cardiovascular disease

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